Healthcare Provider Details

I. General information

NPI: 1245448711
Provider Name (Legal Business Name): AYESHA KAMEELA PEETS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AYESHA KAMEELA PEETS TALBOT MD

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 VERDMONT VALLEY DRIVE
SMITH'S PARISH BERMUDA
FL02
BM

IV. Provider business mailing address

14 VERDMONT VALLEY DRIVE
SMITH'S PARISH BERMUDA
FL02
BM

V. Phone/Fax

Practice location:
  • Phone: 441-236-7961
  • Fax: 441-236-7961
Mailing address:
  • Phone: 441-236-7961
  • Fax: 441-236-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116018849
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101247642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: